Women's health

• DEFINITION: The use of nutrients, dietary supplements, herbal extracts, and alternative therapies for preventing and treating health conditions specific to or predominant in women, such as urinary tract infections, menstrual disorders, menopause, and osteoporosis.

Overview

Although men and women share a majority of health issues, there are many conditions that are specific to women. Women’s health issues are those that are unique to the female anatomy and those that are found primarily in women. Men and women may share similar health issues, but these issues can affect women and men in different ways. Although pain relief is the most common reason for its use, complementary and alternative medicine (CAM) is used throughout the spectrum of women’s health.

Many women use CAM as a form of medical treatment. According to a 2017 Centers for Disease Control and Prevention (CDC) study, women were more likely to use some form of CAM. (Men were more likely to adhere to conventional medical practices.) Financial concerns, mistrust of the healthcare system, toxicity of conventional medicines, and limited access to healthcare are some of the reasons why women turn to CAM. Women who are thirty to sixty-nine years of age and those with a higher level of education are more likely to use CAM.

An increasing number of studies have examined the efficacy of CAM in women’s health. Rigorous scientific-based studies began in earnest in the early 1990s, coinciding with the establishment of the U.S. government’s Office of Alternative Medicine, now called the National Center for Complementary and Alternative Medicine (NCCAM). This center serves as the principal government agency for analyzing medical practices that are outside the scope of conventional medicine. NCCAM also scrutinizes and funds evidence-based research on CAM.

Just as NCCAM examines the efficacy of CAM treatments, it also reviews their safety. Many herbal medicines used in combination or used with conventional medications may have adverse side effects. Women who participate in exercise-based treatments may sustain injuries if they are not physically healthy enough or if supervision is improper.

Genitourinary Infections

Genitourinary infections involve the bladder, kidneys, vagina, cervix, and, rarely, uterus. Women experience infections of the bladder and kidneys far more often than men. The close proximity, in females, of the entrance to the urinary tract (urethra) to the anus makes the risk of urinary infections higher for women than for men. Because urinary tract infections are so common, many women look for inexpensive and convenient treatment options.

Cranberry juice and cranberry-based products have been used by women for decades to treat urinary tract infections (UTIs). There have been no comprehensive, randomized-controlled trials on the use of cranberry juice for UTIs, so there is no scientific evidence to suggest that it is effective. Clinical trials do suggest, however, that cranberry juice may prevent infection in women with recurrent UTIs. A large study sponsored by NCCAM examining the use of cranberry juice for the treatment and prevention of UTIs is currently underway.

Lactobacillus is a probiotic used in the treatment of UTIs, vulvovaginal candidiasis (vaginal yeast infection), and bacterial vaginosis. Probiotics are live microorganisms that are thought to inhibit the growth of unwanted infectious microorganisms. Available clinical data demonstrate that orally and intravaginally administered lactobacillus appears to be effective in treating bacterial vaginosis. The data were inconclusive, however, regarding the effectiveness of lactobacillus probiotics for UTIs and vulvovaginal candidiasis.

Menopause and Osteoporosis

The cessation of ovarian function and, thus, of regular menses is referred to as menopause. Hormonal changes that occur during menopause can cause bothersome effects. Many women experience hot flashes, vaginal dryness, insomnia, and mood disturbances. Because bone density relies in part on estrogen secreted by the ovaries, there is a risk of bone thinning or osteoporosis after menopause. In 2002, the use of hormone replacement therapy drugs containing estrogen dramatically decreased following the announcement of possible health risks. Because of this, many women have turned to alternative medicine to relieve the effects of menopause.

Herbal medicines and nutritional supplements. Black cohosh, evening primrose, soy, gong guai root, ginsing, kava, and DHEA (dehydroepiandrosterone) are products used to treat hot flashes, vaginal dryness, and other symptoms of menopause. The most widely studied and used product is black cohosh. Lacking, however, is scientific evidence supporting the effectiveness of these products in treating menopause.

Soy isoflavones and green tea are widely used in the treatment and prevention of osteoporosis. Soy isoflavones are derived from plant-based soy products and possess estrogen-like activities. Also called phytoestrogens, soy isoflavones are in wide use in many over-the-counter preparations that promote bone health. The American Journal of Clinical Nutrition published a large study of isoflavones in March 2010, and concluded that soy isoflavones did not prevent osteoporosis. Conversely, a large amount of scientific evidence suggests that green tea provides some protection against osteoporosis. Although the antioxidant properties of green tea may be at work, the exact mechanism of action is not known.

Exercise-based therapies.Tai Chi and qigong are traditional Chinese forms of exercise incorporating discrete low-impact movements, breathing, and meditation. In 2010, several large, well-designed studies showed that Tai Chi and presumably qigong were beneficial in preserving bone density in postmenopausal women. In a 2014 randomized clinical trial published in the journal Menopause, yoga reduced hot flashes by about 66 percent. There have been, however, no double-blind studies. The more aggressive forms of yoga, such as ashtanga, vinyasa, and Iyenger, which incorporate weight-bearing activities, can be effective in preventing bone loss. Other research indicates that too much exercise in some individuals may trigger menapause symptoms.

Pregnancy and Infertility

Many women seek to relieve discomfort during pregnancy and labor without conventional medications and invasive procedures. The prohibitive cost of conventional infertility treatment makes CAM an attractive option.

A Cochrane review of clinical studies using CAM in labor demonstrated that acupuncture and hypnosis were effective methods of pain relief. There was no evidence that massage, acupressure, or aromatherapy used to relieve pain during labor had any benefit. Vitamin C and E supplements have been touted to reduce the risk of high blood pressure during pregnancy. A large study sponsored by the National Institutes of Health, however, did not support this claim.

Yoga and acupuncture practitioners and advocates assert that these two CAM methods can enhance fertility. Promising scientific evidence exists that acupuncture in conjunction with in vitro fertilization can increase rates of pregnancy. Furthermore, numerous studies have demonstrated that yoga improves sex performance anxiety and female sexual desire, which can indirectly enhance fertility. Chasteberry has been used for more than two thousand years by women to treat various gynecological disorders, such as infertility; clinical evidence supporting this claim is lacking, however.

Hyperemesis gravidarum is severe, persistent nausea and vomiting that occurs in early and mid-pregnancy. There are alternative treatments that are used to treat this condition. The most commonly used treatments are acupuncture, acupressure, ginger products, and vitamin B₆. A Cochrane review of twenty-seven randomized controlled trials examined these treatments, but the effectiveness of these modalities could not be determined because the studies were conducted in a way that introduced bias. More well-designed studies are needed.

Cancers of the Female Reproductive System

The diagnosis of cancer may bring emotional and physical disruptions to a woman’s daily life. Many women also have doubts about conventional treatment decisions. It is not uncommon for women to turn to CAM to meet their emotional and physical needs. The use of CAM in women with breast, ovarian, and uterine cancer encompasses prevention, cure, and treatments to minimize the side effects of conventional therapies.

Herbal medicines and nutritional supplements.Antioxidants such as vitamin C, vitamin E, coenzyme Q₁₀, and green tea are thought to prevent cancers of the breast, ovaries, and uterus. Also, soy isoflavones and garlic are thought to prevent these types of cancers. Between the years 2002 and 2020 numerous large clinical trials examined the use of antioxidants, soy products, and garlic in the prevention of cancers in women. These studies provided no sufficient evidence to support the claim that most of these products are protective against cancers. However, antioxidants have been linked to a reduction in damage done by free radicals, highly reactive atoms or molecules that can damage the body’s cells. Researchers have theorized that free radical damage may play a role in cancer development.

Studies examining garlic use for ovarian cancer prevention, however, are more promising. Although the National Cancer Institute does not recommend using garlic for cancer prevention, it does recognize that garlic may contain anticancer properties and that more studies are needed to determine this. There are no high-quality studies available that support the use of herbal medicines or nutritional products as a cancer cure.

Physical and mind/body interventions. Meditation, yoga, and hypnosis are often used in conjunction with conventional medicine in the treatment of breast, ovarian, and uterine cancer. Clinical trials have demonstrated that all three modalities are effective in reducing anxiety, pain, and insomnia during cancer treatment, although scientists continue to debate the exact mechanisms of action. Acupuncture may help with nausea during chemotherapy, but more high-quality studies are needed to confirm its efficacy. Art therapy combines the creative process with traditional therapy to allow for the expression of thoughts and feelings. A study of women who had breast cancer showed an improvement of mood disorders when art therapy was applied.

Menstrual Disorders

Menstrual cramps and premenstrual syndrome (PMS) may be a monthly source of physical and emotional distress to premenopausal women. About 35 percent of women experience painful menses on a regular basis. Although a majority of women experience some degree of abdominal bloating, anxiety, irritability, and breast tenderness during the premenstrual period, about 2 percent of women have severe disrupting symptoms. Although these symptoms are typically treated with medications and dietary and lifestyle changes, many women find these modalities intolerable or ineffective and so turn to CAM.

Omega-3, rose hip tea, vitamin B₁ (thiamine), magnesium, vitamin B₆, vitamin E, chasteberry, evening primrose, and calcium are used in the treatment of menstrual cramps and PMS. No clinical trials have provided strong evidence supporting the efficacy of most of these products. Calcium supplementation, however, showed promising evidence as a treatment for PMS. A Cochrane database review found promising evidence supporting the use of a Chinese herbal medicine called jingqianping granules for menstrual cramps and PMS; however, more well-designed clinical trials are needed to confirm this. There is clinical evidence as well that chasteberry is effective in treating the symptoms of PMS and breast pain associated with menses; however, more studies are needed. In a 2019 review of clinical studies published in the journal Evidence-Based Complementary and Alternative Medicine, acupuncture appeared to be a promising treatment for PMS. In a similar review study, transcutaneous electrical nerve stimulation and massage therapy were found to be ineffective in treating menstrual cramps.

Endometriosis, a condition in which cells of the uterus grow in other parts of the body, can cause pelvic pain and severe menstrual cramps. Traditional Chinese herbs are used in the treatment of this disorder. The limited reviews that found traditional Chinese herbs helpful were not high-quality randomized-control trials. Therefore, more study is needed to confirm the efficacy of this treatment.

Conclusions

Despite extensive use of CAM by women, there remains a lack of high-quality scientific evidence to support the effectiveness of most CAM modalities. Rigorous, well-designed clinical trials to determine the effectiveness of CAM therapies for women have become popular only in the twenty-first century. Major studies sponsored by NCCAM are being conducted for a variety of treatment modalities.

Women should not replace traditional medicine for serious medical disorders, such as cancer, with CAM. Women using CAM as a complementary therapy should be aware of the efficacy and safety profile of the treatment before use. The federal government manages the Office of Women’s Health website, which offers resources, statistics, and information on a myriad of women’s health topics. The Centers for Disease Control’s Women’s Health website also offers women’s health resources. However, any individual concerned about their health should consult a medical professional for guidance.

Bibliography

"Antioxidants and Cancer Prevention." National Cancer Institute, 6 Feb. 2017, www.cancer.gov/about-cancer/causes-prevention/risk/diet/antioxidants-fact-sheet. Accessed 20 Oct. 2024.

Avis, Nancy E., et al. "A Pilot Study of Integral Yoga for Menopausal Hot Flashes." Menopause, vol. 21, no. 8, Aug. 2014, pp. 846–54, doi: 10.1097/GME.0000000000000191. Accessed 20 Oct. 2024.

Barnes, P. M., et al. “Complementary and Alternative Medicine Use among Adults and Children: 2007 United States.” National Health Statistics Reports, vol. 12, Dec. 2008, pp. 1-23. Accessed 20 Oct. 2024.

Carlson, L. E. “Mind-Body Interventions in Oncology.” Current Treatment Options in Oncology, vol. 9, nos. 2/3, 2008, pp. 127-34, doi:10.1007/s11864-008-0064-2. Accessed 20 Oct. 2024.

Clarke, Tainya C., et al. "Use of Yoga, Meditation, and Chiropractors among U.S. Adults Aged 18 and Over." National Center for Health Statistics, no. 325, Nov. 2018, www.cdc.gov/nchs/data/databriefs/db325-h.pdf. Accessed 20 Oct. 2024.

Witkowski, Sarah, et al. “Physical Activity and Exercise for Hot Flashes: Trigger or Treatment?” Menopause, vol. 30, no. 2, 2023, pp. 218–24, doi.org/10.1097/GME.0000000000002107. Accessed 20 Oct. 2024.

Zhang, Jiayuan, et al. "Acupuncture for Premenstrual Syndrome at Different Intervention Time: A Systemic Review and Meta-Analysis." Evidence-Based Complementary and Alternative Medicine, 25 June 2019, doi: 10.1155/2019/6246285. Accessed 21 Dec. 2022.

Zoorob, J. R. “CAM and Women’s Health: Selected Topics.” Primary Care, vol. 37, no. 2, 2010, pp. 367-87.